British Journal of Radiology (2004) 77, 171-172
© 2004 British Institute of Radiology
doi: 10.1259/bjr/31782705
An unusual cause of intraluminal gastric radio-opacities
C Offiah, BSc, FRCS, FRCR
and
E N Kumar, MD, FRCR
Department of Radiology, Blackburn Royal Infirmary, Infirmary Road, Blackburn BB2 3LR, UK
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Introduction
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A 30-year-old lady presented with a 3 h history of nausea and epigastric pain, which was worse on lying flat. There was a history of similar episodes in the past, which had settled without requiring hospital admission. There was no history of disturbance in bowel habit and no history of jaundice. Her weight was stable. She denied any history of excess alcohol consumption and gallstones had been excluded previously on ultrasound examination. She was not on any medication at the time of presentation. Clinical examination revealed some tenderness and guarding in the epigastrium on deep palpation but no evidence of rebound tenderness and no palpable masses. She was apyrexial.
Owing to the recurrent nature of her symptoms it was felt that recurrent acute pancreatitis was a consideration and while biochemical markers were awaited, it was decided that a CT of the abdomen should be performed. Two axial sections from the unenhanced series are shown (Figure 1
). Multiple well-defined high density round bodies were observed in the dependent part of the stomach. What is the differential diagnosis for this appearance?
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Discussion
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This appearance of gastric contents on radiographic studies would most commonly be attributable to recently ingested undissolved oral medication such as iron sulphate tablets. Another cause that should be considered is ingested foreign bodies associated with pica. Upon further questioning, the patient in our study revealed that shortly prior to the episode of epigastric pain and CT examination she had rather hastily consumed a meal of Heinz baked beans on toast.
The appearance of baked beans — a very common part of meals, especially in hospitals — demonstrated on the CT had not been encountered before. Nor had it been previously reported in any literature search that we undertook. (We could not find any such reference in our literature search). We performed axial sections therefore through a container of Heinz baked beans to see if this indeed was the cause of the unusual appearance of this patient's gastric contents. The CT appearances were identical (Figure 2). In particular, the high attenuation appeared to relate to the baked bean itself as opposed to the sauce, which made up the preparation. Having confirmed therefore that the contents of the patient's stomach were due to the hastily consumed undigested Heinz baked beans we sought to determine whether the appearances were specific to the Heinz brand or represented an appearance common to undigested baked bean products in general. Axial sections were performed through a container of Tesco baked beans. Again identical high attenuation appearances to the baked beans were demonstrated (Figure 3).
The very high attenuation of these two products suggested that a likely cause would be related to the iodine content of the beans. Vegetables are not a particularly good source of iodine and there was no evidence in the literature to suggest that beans were a more significant dietary source than any other vegetable [1]. What was clear however was that the iodine content of vegetables is highly dependent on the iodine content of the water that irrigates the land on which they are grown [1]. In addition, baked beans are a good source of other trace elements, most notably magnesium, potassium, manganese and molybdenum [2]. We decided also to focus on the ingredients of the baked bean products themselves in terms of additives. An additive that is used in a number of tinned and packed commercial products such as cherries and baby foods is a substance called erythrosine, which is used mainly as a colouring agent. This compound is high in its iodine content [3, 4]. However there is little evidence to suggest that this is an additive used in commercial baked bean products. No mention is made of erythrosine either on the ingredients labels of these products or in the Heinz information website [5]. The other possibility considered related to the ingredients of the tomato sauce component of the product. There is little mention in terms of the ingredients of the tomato sauce on the baked beans packaging. However the tomato sauce used in similar products such as tinned spaghetti and hoops is frequently fortified both with potassium iodide and with iron sulphate. Maybe a similar fortified sauce is used in the commercial baked bean products and it is this that adsorbs to the baked bean and causes the high attenuation demonstrated on CT.
Received for publication March 7, 2003.
Revision received May 12, 2003.
Accepted for publication June 11, 2003.
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References
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- Thomas B. Trace elements. In: Thomas B. Manual of dietetic practice (2nd edn). Oxford, UK: Blackwell Science, 1994:173–83.
- Williams SR. Minerals and Appendix A. In: Williams SR. Essentials of nutrition and diet therapy (7th edn). St Louis, MO: Mosby, 1999:147–83, 550–639.
- Poulsen E. Case study: erythrosine. Food Addit Contam 1993;10:315–23.[Medline]
- Bidlack WR, Wang W. Designing functional foods. In: Shils ME, Olson JA, Shike M, Ross AC, editors. Modern nutrition in health and disease (9th edn). Philadelphia, PA: Lipincott Williams and Wilkins, 1998:1823–33.
- www.heinz.co.uk
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R Whitehouse
Baked beans on CT
Br. J. Radiol.,
September 1, 2004;
77(921):
803 - 803.
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